Predictors of hypoxemia in children with acute lower respiratory tract infections

Acute lower respiratory tract infections [ALRI] are the leading cause of morbidity and mortality among children in developing countries, causing one - third of all deaths in childhood. Pulse oxymetry is a simple technique to determine the oxygen saturations. It is important to accurately identify hypoxemic children by use of clinical signs alone. A well matched case control study was performed on 104 children from 2 months to 5 years ot age admitted with ALRI to the emergency department of Children Welfare Teaching Hospital -Medical City - Baghdad in the period from 15[th] March -15[th] June 2006. Clinical symptoms and signs were recorded. Hypoxemia was defined as oxygen saturation less than 95%. The ability of various clinical symptoms and signs to predict the presence of hypoxemia was evaluated. Fifty [48.1%] children were hypoxemic. The median O[2] saturation was 91.2% with a range of 82-94% Physical signs including tachypnea, intercostal and subcostal retractions, supraclavicular recessions, grunting and nasal flaring were statistically significantly associated with hypoxemi. Use of combinations e.g. Tachypnea or head nodding [P. 0.02, sensitivity 70%, specificity 48%], tachypnea or suprasternal recessions [P.0.05, sensitivity 70%, specificity 44%] only slightly improved the predictive ability. None of the clinical features either alone or in combinations have sufficient sensitively and specificity to predict hypoxemia in children with acute lower respiratory tract infections, therefore pulse oxymetry is desirable for identification of hypoxemia

Respiratory distress in full term newborns

Respiratory distress [RD] is among the most common symptom complexes seen in the newborn infant. It may result from both non-cardiopulmonary and cardiopulmonary causes. This study Aimed to assess the incidence, some possible risk factors, types, and short term out come of RD in full term newborns. A prospective study extending along a 6 months period from 1[st] of October 2006 to 31[st] of march 2007, during which a 50 full term newborns with RD, who were admitted to the NICU of Baghdad Teaching Hospital in Medical City-Baghdad, and enrolled with another 50 full term newborns without RD delivered in the same period, in the same place. For studied groups [cases and controls], a full prenatal and natal history, and complete physical examination were done, including Down's score evaluation of RD. For each patient in the studied group, CXR, CBP, CRP, Bl.C/S were under taken, close observation and out come were recorded. The risk factors that emerged as being significant includes: history of maternal smoking, caesarian section delivery and male sex .The elective caesarian delivery was highly significant risk factor for RD in full term newborns. The incidence of RD in full term newborns to the total live births at that period was [2.16%], TTN was the commonest cause [1.68%], followed by HMD [0.25%], MAS [0.086%], CHD [0.086%] and then C. P [0.001%]. That RD in full term newborns is still an important problem in this NICU, especially due to TTN and following elective CS. These prompt us to recommend the reduction of these risk factors especially elective CS to decrease the incidence of RD in full term newborn babies

Anticipating mechanical ventilation in children with Guillain-Barre syndrome and improving outcome of the illness

Acute inflammatory demylinating polyneuropathy [Guillan-Barre syndrome] is the commonest cause of acute neuromuscular paralysis in most countries. The onset of symptoms in patients with GBS can either be acute or sub act Nentilatory failure is primarily caused by inspiratory muscles weakness although weakness of abdominal and accessory muscles of respiration, retained airway secretion leading to aspiraton and atelectasis are all contributing factors. Nutritional support of critically sick children is important for metabolic maintenance and tissue repair. To identify clinical and respiratory feature associated with progression to respiratory failure in children with GBS. Twenty two consecutive children with severe[Rapidly progressive] GBS admitted to the RICU in Children Welfare Teaching Hospital-Medical City-Baghdad, between July 2004-July 2006. were studied Other 22 cIhildren with sub acute GBS who didn't receive mechanical ventilation admitted in the same period to the same hospital as a control group. There is significant association between each of bulbar, autonomic neuropathies and low SiO2 at admission with severe GBS There is significant reduction in duration of mechanical ventilation and duration of RICU stay achieved by the use of freamine amininacid solution as partial parenteral nutrition. Progression to mechanical ventilation was highly likely to occur in those patients with rapid disease progress. [less than one week] bulbar dysfunction and dysautonomia and low SiO2 at admission. Partial parenteral nutrition may reduce the duration of mechanical ventilation and RICU stay by about 3 days

Congenital malformations in the west of Iraq

CM is the leading cause of infant deaths and account for much greater proportion of infant mortality than does premature birth. A malformation is a primary structural defect arising from a localized error in morphogenesis. This is a prospective study devoted to define the causes and frequencies of congenital malformations [CM] in Maternal and Children Hospital [MCH] in Al-Anbar governorate [west of Iraq] and a comparison is done with other Iraqi and international studies. Congenital malformations were studied over a period of 2 years from the 1[st] of July 2000 to the 30th of June 2002 in 12831 births including stillbirths at MCH in Al- Anbar governorate [west of Iraq]. A control group of 100 women who gave birth to normal newborn babies was studied similarly. The overall birth prevalence of CM is 8.5/1000 births [109/12831] and stillbirth prevalence is 21/1000 [269/12831] births. The most common system involved in CM is the CNS that constitute 55% of total CM followed by skeletal system 33% then GIT 7% urogenital 2% recognized syndromes 2%, and others 1%. This study shows a significant association between each of stillbirth, LBW, polyhydramnios, parental consanguinity advanced maternal age and family history of CM. The present study shows no significant association with each of urban /rural status, and sex, attending antenatal care, tonics, fever, UTI, and diabetes mellitus. The overall birth prevalence of CM is almost the same as that recorded by Al-Saadoon et al in Basra which was 8.7/1000 in the year 1994 and lower than the birth prevalence of CM recorded by Grover-N in India in the year 2000 which was 17.8/1000 Associations between some of the risk factors and CM are similar and others are different from other studies

Epidemiological, clinical profiles and outcome of bronchiolitis in Iraqi children

Bronchiolitis is the first episode of wheezing associated with low-grade fever, rhinitis, tachypnea, and increase respiratory effort in a previously healthy infant during the winter months. It is the most common disease of the lower respiratory tract. This is a case control study carried out on one hundred infants with a mean age of 3.9 months +/- 2.2 months admitted to Children Welfare Teaching Hospital in Medical City -Baghdad with acute bronchiolitis during the period from 1[st] January 2006 to 1[st] April 2006. epidemiological risk factors, clinical presentations, chest X-ray findings, treatment, complications and outcome were analyzed. Another one hundred infants [age and sex matched] were seen in the outpatient clinical in the same period and for health problems other than bronchiolitis were taken as a control group. Chi square test was used and a P<0.05 was considered significant. It was found that 64% of patients were males and 36% were females M/F: 1.9/1, 80% were <6 months and 20% were >6 months of age. Most cases [87%] were admitted on January and February. Bronchiolitis was uncommon and less severe in neonatal period. There was a significant association between urban residence and acute bronchiolitis. There was no significant association between each of family history of atopy, parental smoking, pets at home and crowding index > 30 with bronchiolitis. Fever >38.1C was significantly more common in infants with bronchiolitis > 6 months of age than those less than 6 months. The mean clinical scores of severity, the mean duration of hospitalization and Chest X-ray findings were higher in: male sex, age <6 months, infants who were on exclusive breast feeding. Corticosteroids did not reduce the duration of hospitalization in children with acute bronchiolitis

Neurological manifestations in type- 1 diabetes mellitus in children

Diabetes mellitus type-1 is the most common endocrine metabolic disorder in childhood. Mononeuropathy, generalized polyneuro-pathy and autonomic neuropathy are frequent complications of diabetes mellitus and may give rise to troublesome manifestations. Sixty children suffering from type 1 diabetes mellitus admitted in Children Welfare Hospital- Medical City-Baghdad in the period from 1st Dec2 000-31st July 2001 were included in this prospective descriptive study. History, especially symptoms of peripheral neuropathy, examination specially signs of peripheral neuropathy, absent sinus arrhythmia and postural hypotension and investigations like nerve conduction study were all performed and analyzed. The study showed that out of 60 diabetic children 26[43.3%] had symptomatic polyneuropathy, 18 [30%] had postural hypotension and 16 [26.6%] had absent sinus arrhythmia. Neurological manifestations of diabetes mellitus occur frequently in diabetic children with long duration of illness. Polyneuropathy is sensory more than motor and affected the lower limbs more than the upper limbs. Early diagnosis of autonomic neuropathy in diabetic children is simple easy and requires minimum cooperation, so as detection of peripheral neuropathy in asymptomatic by nerve conduction study

B- thalassemia major in Ramadi

The thalassemia's are a heterogeneous group of genetic disorders in which the production of not-ma1 hemoglobin is partly or completely suppressed because of a defective synthesis of one or more globin chain-In Iraq, B - thalassemia major is widely distributed all over the country. An active program for the hereditary blood diseases had been adopted in cooperation with WHO in 1989. This study is done to evaluate the burden of the disease and its treatment on thalassemic patients in Ramadi. Thirty-one children with B- thalassemia major [17 males and 14females] aged 9 months- 21 years attending the thalassemic clinic in MCH in Ramadi during the period from 1[st] Dec. 2001 to 31[st] May 2002 were studied prospectively. _History, clinical examination, investigations, treatment and its complications were noted and analyzed. Statistical analysis was done by the use of SD, t-test and P value of <0.05was considered statistically significant. 90% had pretransfusion Hb <9gm/ dl. Only 27% received Desferal regularly subcutaneously by infusion pumps. Splenectomy was done in 19.3%, all of them received pneumococcal vaccine and half of them received Benzathine penicillin regularly monthly. Body weight and height below 3rd percentile were noticed in 22.5% and 32.2% respectively. About 32% had myocardial systolic or diastolic dysfunction detected by Doppler echocardiography. None had hypocalcaemia. HBs Ag positive in 6.4%. Anti HCV was positive in 12.5%. None was positive for HIV. _The majority of patients were undertreated and various complications were probably related to chronic anemia rather than iron overload

Epidemiological, clinical and laboratory studies of favism [G6PD] in children

This study reports the epidemiological analysis, clinical presentation, laboratory findings and progress of fifty children admitted to "Al-Mansur Teaching Children Hospital", "Saddam's Medical City" during the period from 1st. January 1990 - 31st December 1994, with G6PD deficiency and acute hemolytic anemia after fava bean ingestion. No cases of favism were observed in breast fed babies whose mothers had eaten fava beans, or from pollen inhalation. 10% of the patients had a previous similar attack, 18% had a family history of favism. [86%] of the patients were males. The main age group affected was 2-4 years [66%]. 90% of cases were from Urban and 10% were from Rural areas. 76% presented during the fava bean season, the onset of symptoms started within three days after fava bean ingestion in 94%, the mean value of Hb was 6gm/dl, Hct 19.9%, Reticulocyte count 8.2%, Total bilirubin 5.2mg/dl, Indirect bilirubin 4.3mg/dl. All patients received blood transfusion and achieved good progress